Senior Coordinator, Complaint & Appeals

CVS Health

Senior Coordinator at CVS Health overseeing appeals scenarios and ensuring compliance. Collaborating with teams to investigate issues and report on findings in the healthcare sector.

Posted 7/21/2026full-timeRemote • California • 🇺🇸 United StatesSenior💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing appeals processes, ensuring compliance with Federal and State regulations, and effectively communicating with stakeholders. Proficient in researching claims, benefits, and administrative denials to resolve complex issues in a fast-paced environment.

Highest-signal resume keywords

Appeals ManagementCompliance and Regulatory AnalysisMedicare and Medicaid KnowledgeBenefit Language ResearchExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingProduct and Contract DraftingPatient ManagementSpecial InvestigationsProvider RelationsAudit Experience

Soft Skills

Organizational SkillsSolution DrivenAbility to Handle Complex Issues

Industry Keywords

Federal RegulationsState RegulationsCustomer ServiceHigh Volume EnvironmentInventory Management

About the role

Key responsibilities & impact

Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products
Ensure timely, customer focused response to appeals
Independently coaches others on appeals ensuring compliance with Federal and/or State regulations
Manage control and trend inventory, independently investigate, adapts to changes or revise policy to resolve the most escalated cases
Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit
Identify correct resource and reroute inappropriate work items that do not meet appeals, complaints and grievance criteria
Research Standard Plan Design or Certification of Coverage relevant to the member to determine accuracy/appropriateness of benefit/administrative denial
Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process

Requirements

What you’ll need

At least 2+ years in one of the following areas: claim platforms, products, and benefits; patient management; product or contract drafting; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience
Some Medicare and/or Medicaid knowledge
Experience in reading or researching benefit language
Ability to work in fast paced, high volume environment
Excellent verbal and written communication skills
Excellent organizational skills to handle high inventory which aids in meeting or exceeding metrics
Solution driven and can handle complex issues with accuracy

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs